Figure 1. The stakeholder groups constructing Living Labs targeting EIDs, adapted and updated from Steen & van Bueren, 2017 (70).

LLs are fit to address the issue of feasibility and temporary collaborations through an inclusive, planned process, where solutions are planned in a precautionary manner. Participants representing diverse stakeholders and sectors jointly create an intervention plan, which aims to accommodate interests of all sides and respects limitations. Given the highly diverse legal environment on various regional levels, LLs consist of a select group of stakeholders with expertise relevant to the scientific, legal, geographical, economical and social conditions of a well-defined pathogen system. This creates a highly flexible and adaptable tool operating based on specific guidelines, but always adopted to the local environment.

LLs addressing disease prevention on a regional level should furthermore always be in close collaboration with Citizen Science and community programs engaging members of the exposed, susceptible population. The following section described the tools necessary for dealing with EIDs on a local scale.

In case of a novel emergence, the initial absence of available information leaves an extremely narrow time window for reactive action. Additionally, due to the cultural and socio-economic diversity of directly affected communities, disease management often suffers from low feasibility and inefficient implementation (71–73). Similar as described for the regional scale, the DAMA protocol facilitates bottom-up processes and the involvement of local actors in both data gathering and generating solutions. Building working relationships with members and local experts of exposed communities creates mutual benefits by increasing the efficiency of implementing disease control measures, and building trust and collaboration between authorities, science and society.

Citizen or Community Science (CS) initiatives are founded to include locals as active participants in research projects targeting their direct environment. With insights provided by patients, farmers, students, hunters and hikers, CS has been invaluable in tracking insect and tick vectors (55,74), avian influenza in urban environments (54) and wildlife health (75).

Similar to preparation, disease prevention also relies heavily on completing scientific data with traditional insights and observations regarding reservoirs. CS programs provide an opportunity for outreach and contact with communities most exposed to emergence (e.g. urban minorities, underserved communities, students, rural farmers, etc.). Emphasis is placed on establishing communication channels and training programs between susceptible communities, public health and scientific research, creating long-term science-practice collaborations, which will serve as a foundation for continued monitoring and early warning systems. When mapping the distribution of a reservoir and/or vector of a suspected pathogenic microbe, local expertise and traditional insights on reservoir behaviour and distribution will be fundamental to conducting efficient monitoring. A further benefit of such initiatives is building the science - society trust bridge, which faces a difficult test during a public health emergency. Finally, including locals in the process, including in LLs (see above), grants ownership over outcomes and intervention plans to those on whom policies are acted on.

When targeting a community, it is just as important to make sure the members involved are relevant to the research and policy issue at hand, as it is to contact groups that are likely to positively respond to this research collaboration. Local organisations not only have in-depth knowledge about their community members, they already have the relevant network and infrastructure for reaching out and advertising opportunities. Although each program should consider the local setting and structure of the community, good examples to reach out to are (Figure 2.):

Community-based organisations - these organisations are founded and run by members of the community advocating for particular issues and rights, and therefore collect proactive groups of locals that could be approached with a CS initiative. Typical examples are Environmental Protection Groups, Neighbourhood Associations or Volunteering Clubs.

Educational institutions - gathering young members of the community who are currently or have been exposed to scientific knowledge makes educational institutions a prime target for CS programs, often building cohorts of volunteers who remain active in the research program even after leaving the institution. High schools, GED (General Educational Development) programs or colleges are only a few examples.

When designing a CS program, we aim to establish a long-term mutually beneficial relationship with key members of the community. This requires not only initial investment into recruiting data samplers, but must also run parallel with feedback and networking activities. The long-term goal of successful CS programs is not necessarily constant data influx, but the foundation of a dynamic network of locally trained experts and researchers which remain in touch and can be mobilised or expanded. This permanent working relationship is further fostered by selecting reliable and committed participants for leadership positions within the CS program.

Although initiatives targeting health disasters have been widely introduced, including the integrated ‘One Health’ surveillance, a common issue is barriers in the way of societal implementation, such as lack of efficient communication, fluctuating compliance and engagement, and territorial fragmentation (76). Disease prevention relies on long-term monitoring of both pathogen and reservoir populations; it is therefore crucial to have a permanent program in place that engages citizens, collects data and knowledge and feeds information back to the community.

After establishing a CS program, opportunities must be provided for consistently involved, engaged members to immerse within the project, gain agency and ownership over the issue at hand. Selecting candidates for leadership positions creates a network of so-called paraprofessionals who are then able to head particular tasks, assist with training, lead recruitment and participate in feedback. A regular income assigned to such positions also increases livelihood, as well as trust and cooperation with authorities. Paraprofessionals have been indispensable in addressing livestock (77) and human diseases (78), and should therefore be cornerstones of EID prevention efforts.